Polycystic ovary syndrome at a glance
- Polycystic ovary syndrome (PCOS) is a condition affecting reproductive age women and can result in infertility due to problems with ovulation (releasing an egg on a monthly basis).
- The cause of PCOS is unknown, but it is the most common hormonal imbalance in women, affecting as many as 1 in 10 women of childbearing age in the United States, according to the U.S. Department of Health & Human Services.
- Symptoms of polycystic ovary syndrome include irregular menstrual periods, weight gain, excessive hair growth, acne and other health concerns like diabetes and high cholesterol.
- While there is no cure for PCOS, lifestyle changes and medications can help patients manage symptoms. A variety of fertility treatments such as ovulation induction medications can help women with PCOS conceive.
What is PCOS?
Polycystic ovary syndrome is a condition that can affect the ability of women of childbearing age to conceive.
Polycystic ovary syndrome is considered one of the most common hormonal disorders in reproductive-aged women, affecting 1 in 10 women of childbearing age in the U.S. While the exact cause of PCOS is currently unknown, many experts think that genetics may be a factor.
Typically, women with polycystic ovary syndrome struggle with infrequent or lack of ovulation and evidence of increased androgen sex hormones (like excessive or male-pattern hair growth and acne). However, some women will have fewer outward signs of the syndrome. There is currently not “one test” to diagnose PCOS. A doctor can diagnose polycystic ovary syndrome by taking a thorough menstrual history, performing an ultrasound of the ovaries and a few hormone blood tests.
Women often become concerned about polycystic ovary syndrome when they are trying to have a baby. When the female body produces elevated levels of androgen hormones, including the hormone testosterone, it can cause a woman’s ovaries to not properly develop a mature egg for release (ovulation) each menstrual cycle. Without ovulation, sperm and egg do not get a chance to meet, making it impossible to get pregnant naturally.
Common PCOS misconceptions
- PCOS is caused by obesity. Diet and weight can contribute to the symptoms of polycystic ovary syndrome, but women of all sizes can, and do, have polycystic ovary syndrome.
- PCOS only occurs in older women. Because many women trying to start a family are in their 30s, PCOS is often diagnosed around this age, but the condition often presents in a woman’s teens and 20s.
- PCOS causes cysts. Despite the name, women with PCOS do not have “abnormal cysts” in their ovaries. A cyst, by definition, is a fluid filled sac. All ovaries contain fluid-filled sacs called follicles. Women with polycystic ovary syndrome simply have more small follicles in their ovaries – leading to the very confusing description of “polycystic” ovaries.
PCOS symptoms and health risks
In our clinic, most often we diagnose a woman with PCOS because her menstrual cycles are irregular and she is having trouble getting pregnant, which is a symptom of polycystic ovary syndrome.
However, not all women with polycystic ovary syndrome experience the same symptoms.
PCOS symptoms include
- Infertility due to lack of, or irregular, ovulation
- Irregular, absent, infrequent or heavy menstruation
- Adult acne
- Excess facial and body hair (called hirsutism)
- Male pattern baldness (androgenic alopecia)
- Dark skin patches (acanthosis nigricans) and skin tags
- Weight gain and obesity.
These symptoms can often lead to anxiety and depression. Women experiencing any number of these symptoms should see their OB/GYN for further evaluation. If fertility is specifically a concern, a fertility specialist (called a reproductive endocrinologist) is recommended.
Because a hormonal disorder can affect the whole body, symptoms can affect different aspects of a woman’s health. These include menstruation irregularity or lack of menstruation, dermatologic conditions, metabolism health and other functions.
For example, infrequent or lack of menstruation disrupts a regular menstrual bleed, causing the lining of the uterus to become thick. This ultimately could lead to the development of pre-cancerous cells or uterine cancer.
The overproduction of androgens during PCOS may also be linked to a decreased efficiency of insulin hormone regulation. Insulin is a vital hormone that converts sugars and other foods into energy. The dysfunctional regulation of insulin in some women with polycystic ovary syndrome may also play a role in their difficulties with ovulation. It is also likely why women with PCOS appear to have a higher risk of developing diabetes.
Metabolic syndrome is also associated with polycystic ovary syndrome. It results in a variety of conditions, from high blood pressure and cholesterol to insulin resistance and diabetes. All of these conditions can increase a woman’s risk of heart disease.
PCOS presents differently in each individual.
In order to reach a diagnosis of PCOS, physicians must identify two of the following three criteria:
- Visible evidence of increased androgens, such as increased hair growth and/or acne, or elevated androgen levels with blood tests
- Infrequent menstrual cycles (≤ 8 per year) or evidence of anovulation (lack of ovulation)
- Ultrasound evidence of “polycystic ovaries” (increased number of follicles in the ovary and/or high ovarian volume).
PCOS is technically a diagnosis of exclusion, meaning other conditions that can look like polycystic ovary syndrome must be ruled out. Unfortunately, patients are often inappropriately diagnosed with PCOS without completing all of the testing to formally rule out other conditions that can mimic PCOS. These conditions require specific treatment that often differs from the treatments for polycystic ovary syndrome.
What are the options for PCOS treatment?
Treatment for PCOS is individualized, depending on a patient’s goals and symptoms.
If a woman is not trying to become pregnant in the immediate future, often birth control pills are prescribed to help reduce the impact of increased androgens (acne and hair growth) and restore a normal menstrual pattern, which is important to reduce the risks associated with the build-up of menstrual lining without a regular bleed. If women would like to avoid using birth control pills, cyclic progesterone or even an IUD (intrauterine device) can be used to reduce risks related to the uterine lining, while other medications, such as spironolactone, can be used to reduce hair growth.
For those who hope to become pregnant, oral ovulation induction with medications such as clomiphene citrate or letrozole are often effective. However, about 30 percent of women will not ovulate even with high doses of these medications and may require injectable hormones to stimulate ovulation. If these treatment options do not result in a successful pregnancy, a physician may recommend more advanced reproductive technology, such as in vitro fertilization (IVF).
For women looking to manage long-term complications of PCOS, maintaining a healthy diet and exercise routine are essential. They should also have regular screening for diabetes and cholesterol as recommended by their primary care provider.
Can PCOS be prevented?
At this point, there is no clear way to determine if a woman will develop PCOS and no “cure.”
So there are no specific steps a woman can take to try to prevent PCOS. However, family history of diabetes, infertility or obesity can be important indicators.
Diagnosing PCOS early can help a young woman manage the symptoms and decrease the chances of long-term complications related to developing diabetes, infertility and heart disease. All women living with polycystic ovary syndrome, regardless of desire to conceive or body weight, can benefit from a healthy lifestyle with regular exercise and good food choices.